2025 年第 9 期 第 20 卷

第二产程产时超声特征对妊娠期高血压疾病孕产妇分娩方式的指导及对妊娠结局的影响

The effect of ultrasonographic characteristics of the second stage of labor on delivery mode and pregnancy outcome of pregnant women with hypertensive disorders complicating pregnancy

作者：贺荣荣1杨春荣1穆靓2石紫云1邓超1田美荣1

英文作者：He Rongrong1 Yang Chunrong1 Mu Liang2 Shi Ziyun1 Deng Chao1 Tian Meirong1

单位：1陕西省人民医院产科,西安710068；2陕西省人民医院超声科，西安710068

英文单位：1Department of Obstetrics Shaanxi Provincial People′s Hospital Xi′an 710068 China; 2Department of Ultrasound Shaanxi Provincial People′s Hospital Xi′an 710068 China

关键词：妊娠期高血压疾病；第二产程；产时超声；胎头进展角；胎头-会阴距离；胎头-耻骨联合距离；妊娠结局

英文关键词：Hypertensivedisorderscomplicatingpregnancy;Secondstageoflabor;Intrapartumultrasound; Fetalheadprogressionangle；Fetalhead-perinealdistance；Fetalhead-pubicsymphysisdistance;Pregnancyoutcome

• 摘要：

• 目的 探讨第二产程产时超声特征对妊娠期高血压疾病（HDCP）孕产妇分娩方式的指导及对妊娠结局的影响。方法 回顾性选择2023年1月至2024年9月于陕西省人民医院住院分娩的HDCP孕产妇106例为研究对象，所有孕产妇第二产程均接受产时超声获得胎头进展角（AOP）、胎头-会阴距离（HPD）、胎头-耻骨联合距离（HSD），统计分娩方式和妊娠结局。采用多因素Logistic回归分析影响HDCP孕产妇自然分娩的相关因素，受试者工作特征（ROC）曲线分析AOP、HPD、HSD对HDCP孕产妇分娩方式的预测价值。比较不同第二产程产时超声特征分娩方式以及不同妊娠结局第二产程产时超声特征的差异。结果 共67例孕产妇自然分娩，15例助产，24例转为剖宫产。助产或剖宫产组AOP小于自然分娩组［（102±9）°比（138±14）°］，HPD、HSD大于自然分娩组［（5.6±1.4）cm比（3.1±0.6）cm、（2.52±0.42）cm比（1.21±0.26）cm］（均P＜0.05）。第二产程时长延长，大HPD、大HSD是HDCP孕产妇助产或剖宫产的危险因素，大AOP是自然分娩的保护因素（均P＜0.05）。AOP、HPD、HSD预测HDCP孕产妇分娩方式的临界值分别为125°、4 cm、1.5 cm，曲线下面积分别为0.780、0.761、0.744，三者联合预测曲线下面积为0.915，大于单独预测（均P＜0.05）。AOP＜125°组，HPD≥4 cm组，HSD≥1.5 cm组自然分娩率分别低于AOP≥125°组，HPD＜4 cm组，HSD＜1.5 cm组（均P＜0.05）。发生不良妊娠结局12例，妊娠结局不良组AOP小于妊娠结局良好组，HPD、HSD大于妊娠结局良好组（均P＜0.05）。结论 第二产程产时超声参数AOP减小，HPD、HSD增大与HDCP孕产妇助产或剖宫产，不良妊娠结局有关，联合AOP、HPD、HSD能有效预测HDCP孕产妇的分娩方式。

• Objective To explore the effects of ultrasonographic characteristics of the second stage of labor on delivery mode and pregnancy outcome of pregnant women with hypertensive disorders complicating pregnancy (HDCP). Methods A total of 106 pregnant women with HDCP who were hospitalized and delivered in Shaanxi Provincial People′s Hospital from January 2023 to September 2024 were retrospectively selected as the research objects. The angle of fetal head progression (AOP), the distance between fetal head and perineum (HPD), and the distance between fetal head and pubic symphysis (HSD) were measured by intrapartum ultrasound during the second stage of labor. The delivery mode and pregnancy outcome were recorded. Multivariate Logistic regression was used to analyze the related factors affecting natural delivery in pregnant women with HDCP. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of AOP, HPD, and HSD for the delivery mode of pregnant women with HDCP. The differences of ultrasonographic characteristics of the second stage of labor among different delivery methods  and different pregnancy outcomes were compared. Results A total of 67 women had natural delivery, 15 women had assisted delivery, and 24 women converted to cesarean section. The AOP of the midwifery or cesarean section group was lower than that of the natural delivery group ［（102±9）° vs （138±14）°］, and the HPD and HSD were higher than those of the natural delivery group ［（5.6±1.4）cm vs （3.1±0.6）cm, （2.52±0.42）cm vs （1.21±0.26）cm］(all P＜0.05). The prolonged duration of the second stage of labor, large HPD and large HSD were risk factors for midwifery or cesarean section, and large AOP was a protective factor for natural delivery in pregnant women with HDCP (all P＜0.05). The critical values of AOP, HPD, and HSD in predicting the delivery mode of HDCP pregnant women were 125°, 4 cm, and 1.5 cm, respectively, and the area under the curve was 0.780, 0.761, and 0.744, respectively. The area under the curve of the combined prediction of the three was 0.915, which was greater than that of the individual prediction (all P＜0.05). The natural delivery rate of AOP<125° group, HPD≥4 cm group and HSD≥1.5 cm group was lower than that of AOP≥125° group, HPD<4 cm group and HSD<1.5 cm group, respectively (all P＜0.05). There were 12 cases of adverse pregnancy outcomes. The AOP of the poor pregnancy outcome group was lower than that of the good pregnancy outcome group, and the HPD and HSD were higher than that of the good pregnancy outcome group (all P＜0.05). Conclusion The reduce of AOP and the increase of HPD and HSD during the second stage of labor are related to the midwifery or cesarean section and adverse pregnancy outcomes of HDCP pregnant women. The combination of AOP, HPD and HSD can effectively predict the delivery mode of HDCP pregnant women.